77 Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

77 PHARMACY INC

Doing business as

77 Pharmacy

Practice address

8215 Roosevelt Ave
Jackson Heights, NY 11372-7034

Phone

(718) 898-7777

Fax

(718) 898-7775

NPI assigned

Aug 2, 2021

Last updated

Nov 21, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ronald Rivas

Title

Owner

Phone

(718) 684-1595

Specialties & licenses 1

Addresses

Other names 1

• 77 Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in NY2 enrollments

Enrollment records 2

Tax ID family

77 Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• 77 Pharmacy Inc

  • Long Term Care Pharmacy
  • Jackson Heights, NY
  • NPI 1255296299
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jae Lee, PHARMD

  • Pharmacist
  • Bayside, NY
  • NPI 1457508889
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1627862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732147200000",
    "number": "1194499343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8215 ROOSEVELT AVE",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113727034",
            "telephone_number": "718-898-7777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8215 ROOSEVELT AVE",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113727034",
            "telephone_number": "718-898-7777",
            "fax_number": "718-898-7775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "77 PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-02",
        "last_updated": "2024-11-21",
        "certification_date": "2024-11-21",
        "status": "A",
        "authorized_official_last_name": "RIVAS",
        "authorized_official_first_name": "RONALD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-684-1595"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "77 Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 37TH Ave. Pharmacy Inc.
• 63Rd Drive RX, Inc. (InterPharm Rx)
• 63Rd Drive RX, Inc. (InterPharm Rx)
• 75TH Street Medical PC
• 77 Dental PC
• 77 Pharmacy Inc
• 82ND Dental PLLC
• 84 Street Medical PC
• 90-15 Roosevelt Pharmacy Corp (Mi Farmacia)
• 9301 Health Medical Corner PC

• Community/Retail Pharmacy in Jackson Heights, NY
• Providers in Jackson Heights, NY by specialty
• Community/Retail Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.